Project Summary Many survivors describe cancer as a watershed event in their personal development, a demanding and difficult challenge that nonetheless may result in some positive changes in themselves and their relationships. 1-4 Research into posttraumatic growth (PTG) 3, 5 and the closely related area of benefit finding 6-8 is beginning to address this aspect of the survivor experience. Unlike studies of behavioral or mental health outcomes, where existing measures may be adequately developed and validated, this research requires conceptualizing broad personality constructs and developing new measures for them.9, 10. This is particularly challenging since the personality traits that are the focus of research (e.g. coping, optimism) may themselves alter the ways survivors respond to conventional psychological measures. The cancer experience and efforts to cope with its physical and emotional effects are now understood to alter survivors'perceptions of themselves and their subsequent health conditions.6-8, 11-18 To the extent that survivors evaluate themselves differently following their cancer, interpretation of their self-reported health ratings is made complex. To what extent are survivors'reports of growth affected by changes in self-appraisal? While reports of positive changes after cancer have been interpreted as evidence of growth, 3, 4, and 19 some studies conclude that self-reported growth is driven by changes in survivors'self-appraisals rather than actual changes in behavior or internal states. 8, 20-22 Building on research in personality and social psychology this study employs the construct of self-enhancement bias (SEB), defined as a characteristic tendency "to give self-reports that are honest but positively biased,"23 to investigate how changes in self-appraisal may contribute to self-reported growth after cancer. Evidence of SEB in cancer survivors comes from studies showing survivors are more likely to have a repressive coping style24-28 than non-cancer controls, 26 28-34 and that repressors report fewer symptoms of distress and posttraumatic stress.31, 35 Using a recently validated measure, the Balanced Inventory of Desirable Responding,36 the study investigates SEB in a group of long-term Hodgkin's disease (HD) survivors and sibling controls., 200 survivors and 200 controls from an existing research cohort will be recruited for a cross-sectional mailed survey. Self-report of posttraumatic stress (Posttraumatic Diagnostic Scale)37 and PTG (Post Traumatic Growth Inventory),38 will be used to measure these positive and negative aspects of survivors'psychological adjustment, and follow-up on reports that each is linked to response bias.20, 35 Study aims will be to: 1) Examine the relationship of SEB to self-reported PTG and posttraumatic stress;2) Compare the level of SEB in long-term HD survivors to sibling controls;and 3) Explore the association of PTG and SEB with treatment factors and health behaviors. The study has important implications for understanding how adaptation to illness affects self-perception, and how these changes may affect survivors'experience of growth, as well as their health behaviors and adherence to follow-up care. PUBLIC HEALTH RELEVANCE: Project Narrative With the population of cancer survivors in the US growing to more than 12 million, it is critical that valid measures of their emotional health and long-term outcomes be developed. This study investigates the ways in which illness alters survivors'appraisals of health and well-being, and the extent to which these changes in health appraisal can affect the validity of self-reported growth and well-being after cancer. Study results have important implications for improving health outcome measures, as well as for understanding how adaptation to illness affects self- perception and self-presentation.